Heather has taught reproductive biology and has researched neuro, repro and endocrinology. She has a PhD in Zoology/Biology.

Did you know that you, well, if you are female, could have something called a cyst in your ovary and not even know it? Learn about ovarian cysts and polycystic ovarian syndrome in this lesson on ovarian disorders.

Ovarian Cycle

You're probably familiar by now with the process of egg maturation and ovulation, but let's take a quick moment to review just in case you need a refresher. You see, each month a group of immature eggs is recruited in the ovary. They receive hormone signals from the hypothalamus and pituitary, two structures at the base of the brain. These hormones, particularly follicle stimulating hormone, or FSH for short, help the eggs mature.

But, only one lucky egg is chosen to mature all the way! When that egg is fully mature, the brain sends a surge of the hormone GnRH down to the pituitary. This creates a surge in the hormone called luteinizing hormone, or LH for short. LH triggers ovulation, or the release of the mature egg from the ovary. And the rest of the egg's journey is a whole other story. For now, we are going to stay within the ovary.

Ovarian Cysts

Okay. So what does this have to do with ovarian cysts? Well you see, as each of the eggs is recruited, they form a fluid filled cavity around the egg called a follicle. You can think of it like a protective bubble that forms around the delicate egg, except, instead of air, this bubble is filled with fluid.

Usually these follicles break down after ovulation, forming a structure called the corpus luteum that produces the hormone progesterone. But in some cases, they tend to stick around a bit longer. A follicular ovarian cyst is when a fluid filled follicle fails to break down and sometimes enlarges after ovulation.

Sometimes though, even when the corpus luteum forms normally, a cyst can still form inside the corpus luteum. These are called luteal cysts - you know, because they form in the luteum - while the follicle cysts form in the follicles. Now, normally the corpus luteum goes away if pregnancy does not occur. But sometimes it sticks around and enlarges, causing a luteal cyst. These are usually symptom free, and you might not even know you have one, unless of course they enlarge too much and cause bleeding or discomfort.

Alright, maybe that sounds a little worrisome. Bleeding in your ovary? But don't worry. Even though cysts are the most common form of ovarian tumors, they are benign, meaning cancer free. Good thing, right? And in most cases, these go away on their own over time.

PCOS

However, sometimes the formation of cysts can get out of hand, and multiple cysts can form inside the ovary, like its being filled up with lots of little water balloons. When this happens, it can interfere with the normal maturation of the eggs. So how do you know if this is happening?

Well, if the eggs fail to mature normally, then, they also fail to ovulate, right? Because we wouldn't want the ovary to release an egg that wasn't ready! And this can cause the woman to have irregular or a complete lack of a menstrual cycle.

One of the first things a doctor checks for when a female complains of this is polycystic ovarian syndrome (PCOS). In PCOS, the presence of multiple follicular cysts on one or both ovaries can be detected through an ultrasound - that's the same device used to view babies in the mother's womb.

While you may think these cysts cause PCOS, they are actually a result of the syndrome. The cause of PCOS is thought to be the failure to mature and ovulate eggs. And, since ovulation is associated with hormone levels, what do you think might happen to hormone levels? Well, they are probably altered, or not normal, right? It's kind of like the communication signals between the brain and the ovaries aren't working properly, and the message to mature and ovulate is lost in translation.

In fact, women with PCOS often have excess LH but decreased FSH, meaning that the ovary doesn't have the right signals to mature and release developing eggs.

Some other things associated with PCOS include higher androgen levels, (that's the male hormone testosterone), which can also prevent egg development and, on the side, can cause excess hair growth.

And, like many diseases, there are risk factors that make you more likely to develop PCOS. These include a family history of PCOS, obesity and insulin resistance, and, since these are also signs of diabetes, it makes sense that type 2 diabetes would also be a risk factor.

So, you may be asking 'how do you treat PCOS?' Well, research has shown that the best treatment so far seems to be targeting the excess insulin levels. See, too much insulin makes the body insensitive to it, so by treating with drugs that make the body more sensitive to insulin, we can reduce both insulin and androgen levels. This has led to the return of both ovulation and even pregnancy in some patients.

Lesson Summary

So, remember. There are two types of ovarian cysts. Follicular cysts form when the fluid filled follicles that protect developing eggs fail to break down after ovulation, often enlarging. And luteal cysts, just like the name suggests, form within the corpus luteum that forms after ovulation. When both types of cysts enlarge, they can change the appearance of the ovary on the outside, making it look like it has large lumps inside of it.

These cysts are benign, or cancer free, and usually don't come with any symptoms. However, if they get too large, they may cause discomfort or bleeding.

And, in some women, the presence of multiple cysts in one of both ovaries can indicate polycystic ovarian syndrome (PCOS). If a woman is obese or diabetic, meaning they are resistant to the excess insulin in their blood, she is at a higher risk of developing PCOS.

PCOS is characterized by excess LH and androgen levels in the blood, causing problems with egg development and the failure to ovulate. This in turn leads to irregular or an absence of menstruation in the affected women.

Treatment of the excess insulin and androgen in the blood can reverse the syndrome in some patients, restoring the ability to ovulate, and if lucky, the ability to get pregnant.

Summary:

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